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"OUR COLLEAGUES IN AUSTRIA"
914 ] Starvation for a day or two has no labile, pH-labile haemolysin) ; paroxysmal hsemo-resistant. globinuria, Salén (thermostabile" cold " haemolysin,]relieving effect, and the usual means recommended to complement not required) ; acute haemolytic anaemia :antagonise tissue oxygen-want-namely, ammonium chloride and carbon dioxide-are of little value under (haemolysin thermostabile, complement required). In two of our cases of acute hsemolytic anaemia,the above conditions compared with the diet of the blood picture superficially resembled that of carrots. Experiments are in hand to isolate any third in the the substance active which may be present and act as a anaemia ; one, pernicious outstanding features were microspherocytosis and increased detoxicating agent for the liver, heart, brain, and fragility, as in congenital haemolytic jaundice. We other organs, or which may be of the nature of a felt that the abnormal blood picture might be due to peroxidase or other enzyme. the haemolysin, since with recovery and gradual disI am, Sir. yours faithfully. J. ARGYLL CAMPBELL. appearance of hsemolysin the blood picture became National Institute for Medical Research, N.W., April 6th. normal. Our experimental studies with acute heamolytic anaemia bear out our original conception that HEARING-AIDS FOR DEAFNESS microspherocytosis and increased fragility may be due to the activity of a haemolytic agent rather To the Editor of THE LANCET than to a fundamental abnormality of cellular SiR,—Neither of your correspondents has made production in the marrow. any allusion to two points of importance that must We feel that the result of all this recent work, as be taken into consideration when advising any form quoted by THE LANCET, has been to reopen the entire of hearing-aid to a patient. One concerns a necessary subject of the haemolytic syndromes. These were precaution connected with its use, the other with its rather thoroughly explored by the French between source. 1900 and 1914, and later by the Italians. From 1926 The permanent use of an aid slowly but surely to the present, the investigations in pernicious anaemia increases the deafness, because every aid acts by and more recently in hypochromic anaemia became so carrying, and magnifying sounds. This absorbing, however, that the haemolytic syndromes collecting, causes the ears to become" lazy," and the important ‘
,
’
almost forgotten. May TnE LANCET continue to record the forthcoming advances. We are, Sir, yours faithfully, WILLIAM DAMESHEK, STEVEN O. SCHWARTZ. Boston, lSassachusetts, March 24th. were
OXYGEN-WANT AND ITS ALLEVIATION
To the Editor
of THE LANCET SiR,—Although a large proportion of patients obtain relief from oxygen-want by means of oxygen and carbon dioxide therapy there is still much room for improvement. This leads to the consideration of other means of relief-for example, whether there some substance or enzyme which could be administered to aid oxidation in the cells when these are exposed to oxygen pressures lower than the normal. During the past six months I have directed attention to the search for such a substance. I have tested, in vivo, most of the usual hormones, vitamins, and drugs, including cardiac stimulants. None of these seem to give any very definite aid during exposure to severe degrees of acute oxygen-want. The experiments have been carried out in a small decompression chamber at the premises of Messrs. Siebe, Gorman and Co., S.E.1, to whom I am indebted for facilities. White rats weighing about 80-100 g. have been exposed fairly suddenly to barometric pressure 250 mm. Hg, or one third of the normal (oxygen pressure about 7 per cent. atmosphere), for about 35 minutes. When the surrounding temperature is kept at 24° C. all the rats usually survive the exposure and these conditions are used to test for substances which enhance oxygen-want. When the surrounding temperature is raised to 33° C. the rats cannot as a rule tolerate such a degree of oxygen-want for more than about 10 minutes. These conditions test for substances which are therefore used to increase powers of resistance to low oxygen pressure. So far the only condition which enables white rats to tolerate 7 per cent. of oxygen for 30 minutes at 33° C. and survive is previous feeding for 3-5 days The active on a diet consisting wholly of raw carrots. substance is not vitamin A ; nor does it appear to be carbohydrate since rats fed on a grain diet are not
may be
listening function is thus thrown into abeyance. Consequently a time comes when the patient finds himself obliged to obtain stronger aids. Indeed, one French writer has envisaged a patient finally going about accompanied by a wheel-barrow full of batteries. As a consequence of this impairment of the listening function, it is imperative to prevent it by insisting that all patients using aids should carry out twice daily some form of listening exercise. Such exercises are comparable with voluntary movements during the recovery of a limb which is already receiving passive exercises. My second point is that it is the duty of the aurist to ensure that his patient goes to an honest firm for his aid. Some surgical instrument makers now have special departments under competent experts for hearing-aids. These cooperate loyally with the surgeon and do not charge extra fees for trial. There on the other hand, certain commercial firms who advertise continuously and flamboyantly in the daily press and whose sole object is to exploit the deaf public for all it is worth. Their prices are exorbitant and they charge fees for trial which are not allowed for when a purchase is made. These firms do not worry about decibels, possibly because they have not yet heard of them. I am, Sir, yours faithfully, MACLEOD YEARSLEY.
are,
"OUR COLLEAGUES IN AUSTRIA"
To the Editor
of
THE LANCET
Sm,-I should like to express most heartily my agreement with the common-sense protest made by Mr. Goodwin and Dr. Endean against the policy of encouraging Jewish emigres from Middle Europe to practise in this country. The medical profession is very overcrowded and often for one vacant appointment there may be as many as thirty candi. dates, all of whom may be excellent men who would fill the job admirably. Under such circumstances how can it ever be shown " (Prof. conclusively Samson Wright) " that the applicant’s (for permission to practise) special knowledge and experience would be of benefit to the profession as a whole" It might be pertinent to inquire whether other pro-
now
"
915 are suggesting the same policy, and whether lawyers, engineers, civil servants, and so forth in this country are welcoming fresh competition in the shape of Jewish refugees from Middle Europe ; or is ours the only profession encouraging this misplaced philanthropy ?z? I am, Sir, yours faithfully,
fessions
A. C. LYSAGHT. To the Editor
of
THE LANCET
SiR,—I, like those others who have written to you,
strongest possible sympathy for those who have been forced to leave Austria for racial or political reasons and would like to see them safely installed where they are unlikely to be subjected to further persecution. Nevertheless I cannot agree that we should have a further number allowed to settle in England-even if they are not admitted to the Register. These people are, in most cases, not of independent means and sooner or later they are going to ask to be allowed to practise. There is no doubt that our profession is greatly overcrowded now, and, even in some years, to allow a further number of doctors to practise in England will inevitably lead to hardship. If this occurs it will feel the
undoubtedly breed further antisemiticism in England as it has in Arabia. It may be said that by giving the refugees research grants it is possible for them to do work which is beneficial without interfering with those already established here. This I do not think is true. At the time when the Jewish doctors were first ejected from Germany I was applying for research grants and found it impossible to obtain one. Shortly afterward I found that a large number—I believe eleven-German refugees had research grants in a hospital which I visited. It does not embitter me that I should have made a sacrifice of a grant which I may have obtained otherwise to aid some poor but I feel that we should not be the only country to make sacrifices. It is not surprising to me that those who signed the original letter to you were all established and need not fear " foreign
refugee,
competition. Are there no countries which have a large population but relatively few doctors ? Is there no place for the refugees in India or South America for instance ?Q I would suggest that if the well-meaning folk who would import further competition for the medical men here do not want to raise a new wave of antisemiticism it were better for them to consider the proposition of sending the refugees elsewhere. I am, Sir, yours
faithfully, M.D., M.R.C.P.
INSULIN SHOCK IN PSYCHIATRY
To the Editor
of THE leading
LANCET
article of April 2nd SIR,—I feel that your does not do full justice to the part played by Dr. Sakel in originating the above therapy. Although others before him had been using insulin in psychiatry, the therapy did not exist as such when he introduced it in 1933. His claim, therefore, is a greater one than merely having forced the method to its furthest conclusion. It was Sakel who recognised the therapeutic possibilities of the hypoglycsemio state, and evolved a safe method of producing it. As for Potzl himself having said that the method introduced by Sakel in his clinic at Vienna was the audacious continuation
of earlier work, I respectfully submit that the reference in the original article does not imply that
meaning.
I am, Sir, yours
faithfully,
H. PULLAR STRECKER. Harley-street, W., April 9th.
* * * It historical
possible to consider Dr. Sakel in his setting without disputing his merits as
is
originator of the method now employed. SlotopolskyDukor’s article states the matter clearly. Prof. Potzl, in the article referred to, said of Dr. Pascal’s book published in 1926 : "...hier sind neben vielen anderen Methoden auch Insulinshocks erwahnt, allerdings ohne dass die Methode an einem grossen Krankengut und ausgearbeitet worden ware " and later : verfolgt " Ich habe diese langere Einleitung vorausgeschickt, weil ich dartun wollte, dass eine Shockbehandlung der Schizophrenie, wenn man so sagen darf, ein alter Gedankengang war, der nur fortgedacht werden musste. In der Durchfuhrung dieses Gedankens, wie die Insulinshockmethode sie enthalt...."—ED. L. INFECTIOUS DISEASE IN
ENGLAND
AND
WALES DLTRING THE WEEK ENDED APRIL 2ND, 1938
Notifications.—The following cases of infectious were notified during the week : Small-pox, 0 ; fever, 2323 ; diphtheria, 1388 ; enteric fever, 8 (20 expected ") ; pneumonia (primary or influenzal), 1205 puerperal pyrexia, 198 ; cerebrospinal fever, 32 ; acute poliomyelitis, 4 ; acute polio-encephalitis, 3 ; encephalitis lethargica, 13 ; dysentery, 111 ; ophthalmia neonatorum, 105. No case of cholera, plague, or typhus fever was notified during the week. disease scarlet
"
The number of cases in the Infectious Hospitals of the London County Council on April 8th was 5596, which included : Scarlet fever, 843 ; diphtheria, 1160 (carriers 51) ; measles, 2241 ; whooping-cough, 291 ; puerperal fever, 14 mothers (plus 8 babies) ; encephalitis lethargica, 281 ; poliomyelitis, 1. At St. Margaret’s Hospital there were 22 babies (plus 9 mothers) with ophthalmia neonatorum. Deaths.-In 125 great towns, including London, there was no death from small-pox or enteric fever, 38 (12) from measles, 5 (0) from scarlet fever, 28 (4) from whooping-cough, 25 (5) from diphtheria, 33 (14) from diarrhoea and enteritis under two years, and 74 (13) from influenza. The figures in parentheses are those for London itself. Measles was fatal in 19 great towns ; Manchester reported 4 deaths, Liverpool 3. Whooping-cough was responsible for 4 deaths in Liverpool, 3 in Birkenhead and Hull. Diphtheria was fatal in 17 great towns, Liverpool reporting 3 deaths. The number of stillbirths notified during the week was 290 (corresponding to a rate of 41 per 1000 total births), including 42 in London. PROVISIONAL DEATH-RATES
Provisional death-rates per million population for England and Wales during the year 1937 as follows have been issued by the Registrar-General:-
The maternal mortalitv deaths primarily classed to as follows :-
(provisional) based on puerperal conditions is
,
’
almost forgotten. May TnE LANCET continue to record the forthcoming advances. We are, Sir, yours faithfully, WILLIAM DAMESHEK, STEVEN O. SCHWARTZ. Boston, lSassachusetts, March 24th. were
OXYGEN-WANT AND ITS ALLEVIATION
To the Editor
of THE LANCET SiR,—Although a large proportion of patients obtain relief from oxygen-want by means of oxygen and carbon dioxide therapy there is still much room for improvement. This leads to the consideration of other means of relief-for example, whether there some substance or enzyme which could be administered to aid oxidation in the cells when these are exposed to oxygen pressures lower than the normal. During the past six months I have directed attention to the search for such a substance. I have tested, in vivo, most of the usual hormones, vitamins, and drugs, including cardiac stimulants. None of these seem to give any very definite aid during exposure to severe degrees of acute oxygen-want. The experiments have been carried out in a small decompression chamber at the premises of Messrs. Siebe, Gorman and Co., S.E.1, to whom I am indebted for facilities. White rats weighing about 80-100 g. have been exposed fairly suddenly to barometric pressure 250 mm. Hg, or one third of the normal (oxygen pressure about 7 per cent. atmosphere), for about 35 minutes. When the surrounding temperature is kept at 24° C. all the rats usually survive the exposure and these conditions are used to test for substances which enhance oxygen-want. When the surrounding temperature is raised to 33° C. the rats cannot as a rule tolerate such a degree of oxygen-want for more than about 10 minutes. These conditions test for substances which are therefore used to increase powers of resistance to low oxygen pressure. So far the only condition which enables white rats to tolerate 7 per cent. of oxygen for 30 minutes at 33° C. and survive is previous feeding for 3-5 days The active on a diet consisting wholly of raw carrots. substance is not vitamin A ; nor does it appear to be carbohydrate since rats fed on a grain diet are not
may be
listening function is thus thrown into abeyance. Consequently a time comes when the patient finds himself obliged to obtain stronger aids. Indeed, one French writer has envisaged a patient finally going about accompanied by a wheel-barrow full of batteries. As a consequence of this impairment of the listening function, it is imperative to prevent it by insisting that all patients using aids should carry out twice daily some form of listening exercise. Such exercises are comparable with voluntary movements during the recovery of a limb which is already receiving passive exercises. My second point is that it is the duty of the aurist to ensure that his patient goes to an honest firm for his aid. Some surgical instrument makers now have special departments under competent experts for hearing-aids. These cooperate loyally with the surgeon and do not charge extra fees for trial. There on the other hand, certain commercial firms who advertise continuously and flamboyantly in the daily press and whose sole object is to exploit the deaf public for all it is worth. Their prices are exorbitant and they charge fees for trial which are not allowed for when a purchase is made. These firms do not worry about decibels, possibly because they have not yet heard of them. I am, Sir, yours faithfully, MACLEOD YEARSLEY.
are,
"OUR COLLEAGUES IN AUSTRIA"
To the Editor
of
THE LANCET
Sm,-I should like to express most heartily my agreement with the common-sense protest made by Mr. Goodwin and Dr. Endean against the policy of encouraging Jewish emigres from Middle Europe to practise in this country. The medical profession is very overcrowded and often for one vacant appointment there may be as many as thirty candi. dates, all of whom may be excellent men who would fill the job admirably. Under such circumstances how can it ever be shown " (Prof. conclusively Samson Wright) " that the applicant’s (for permission to practise) special knowledge and experience would be of benefit to the profession as a whole" It might be pertinent to inquire whether other pro-
now
"
915 are suggesting the same policy, and whether lawyers, engineers, civil servants, and so forth in this country are welcoming fresh competition in the shape of Jewish refugees from Middle Europe ; or is ours the only profession encouraging this misplaced philanthropy ?z? I am, Sir, yours faithfully,
fessions
A. C. LYSAGHT. To the Editor
of
THE LANCET
SiR,—I, like those others who have written to you,
strongest possible sympathy for those who have been forced to leave Austria for racial or political reasons and would like to see them safely installed where they are unlikely to be subjected to further persecution. Nevertheless I cannot agree that we should have a further number allowed to settle in England-even if they are not admitted to the Register. These people are, in most cases, not of independent means and sooner or later they are going to ask to be allowed to practise. There is no doubt that our profession is greatly overcrowded now, and, even in some years, to allow a further number of doctors to practise in England will inevitably lead to hardship. If this occurs it will feel the
undoubtedly breed further antisemiticism in England as it has in Arabia. It may be said that by giving the refugees research grants it is possible for them to do work which is beneficial without interfering with those already established here. This I do not think is true. At the time when the Jewish doctors were first ejected from Germany I was applying for research grants and found it impossible to obtain one. Shortly afterward I found that a large number—I believe eleven-German refugees had research grants in a hospital which I visited. It does not embitter me that I should have made a sacrifice of a grant which I may have obtained otherwise to aid some poor but I feel that we should not be the only country to make sacrifices. It is not surprising to me that those who signed the original letter to you were all established and need not fear " foreign
refugee,
competition. Are there no countries which have a large population but relatively few doctors ? Is there no place for the refugees in India or South America for instance ?Q I would suggest that if the well-meaning folk who would import further competition for the medical men here do not want to raise a new wave of antisemiticism it were better for them to consider the proposition of sending the refugees elsewhere. I am, Sir, yours
faithfully, M.D., M.R.C.P.
INSULIN SHOCK IN PSYCHIATRY
To the Editor
of THE leading
LANCET
article of April 2nd SIR,—I feel that your does not do full justice to the part played by Dr. Sakel in originating the above therapy. Although others before him had been using insulin in psychiatry, the therapy did not exist as such when he introduced it in 1933. His claim, therefore, is a greater one than merely having forced the method to its furthest conclusion. It was Sakel who recognised the therapeutic possibilities of the hypoglycsemio state, and evolved a safe method of producing it. As for Potzl himself having said that the method introduced by Sakel in his clinic at Vienna was the audacious continuation
of earlier work, I respectfully submit that the reference in the original article does not imply that
meaning.
I am, Sir, yours
faithfully,
H. PULLAR STRECKER. Harley-street, W., April 9th.
* * * It historical
possible to consider Dr. Sakel in his setting without disputing his merits as
is
originator of the method now employed. SlotopolskyDukor’s article states the matter clearly. Prof. Potzl, in the article referred to, said of Dr. Pascal’s book published in 1926 : "...hier sind neben vielen anderen Methoden auch Insulinshocks erwahnt, allerdings ohne dass die Methode an einem grossen Krankengut und ausgearbeitet worden ware " and later : verfolgt " Ich habe diese langere Einleitung vorausgeschickt, weil ich dartun wollte, dass eine Shockbehandlung der Schizophrenie, wenn man so sagen darf, ein alter Gedankengang war, der nur fortgedacht werden musste. In der Durchfuhrung dieses Gedankens, wie die Insulinshockmethode sie enthalt...."—ED. L. INFECTIOUS DISEASE IN
ENGLAND
AND
WALES DLTRING THE WEEK ENDED APRIL 2ND, 1938
Notifications.—The following cases of infectious were notified during the week : Small-pox, 0 ; fever, 2323 ; diphtheria, 1388 ; enteric fever, 8 (20 expected ") ; pneumonia (primary or influenzal), 1205 puerperal pyrexia, 198 ; cerebrospinal fever, 32 ; acute poliomyelitis, 4 ; acute polio-encephalitis, 3 ; encephalitis lethargica, 13 ; dysentery, 111 ; ophthalmia neonatorum, 105. No case of cholera, plague, or typhus fever was notified during the week. disease scarlet
"
The number of cases in the Infectious Hospitals of the London County Council on April 8th was 5596, which included : Scarlet fever, 843 ; diphtheria, 1160 (carriers 51) ; measles, 2241 ; whooping-cough, 291 ; puerperal fever, 14 mothers (plus 8 babies) ; encephalitis lethargica, 281 ; poliomyelitis, 1. At St. Margaret’s Hospital there were 22 babies (plus 9 mothers) with ophthalmia neonatorum. Deaths.-In 125 great towns, including London, there was no death from small-pox or enteric fever, 38 (12) from measles, 5 (0) from scarlet fever, 28 (4) from whooping-cough, 25 (5) from diphtheria, 33 (14) from diarrhoea and enteritis under two years, and 74 (13) from influenza. The figures in parentheses are those for London itself. Measles was fatal in 19 great towns ; Manchester reported 4 deaths, Liverpool 3. Whooping-cough was responsible for 4 deaths in Liverpool, 3 in Birkenhead and Hull. Diphtheria was fatal in 17 great towns, Liverpool reporting 3 deaths. The number of stillbirths notified during the week was 290 (corresponding to a rate of 41 per 1000 total births), including 42 in London. PROVISIONAL DEATH-RATES
Provisional death-rates per million population for England and Wales during the year 1937 as follows have been issued by the Registrar-General:-
The maternal mortalitv deaths primarily classed to as follows :-
(provisional) based on puerperal conditions is